Health Care Fund Application

Health Care Fund Application
Application Cycle: Spring 2026

To be considered for the Spring 2026 cycle for these funds, applications and expense documentation must be submitted by Monday, April 16, 2026 at 5:00pm. If you have any questions, please email 33@yaleunions.org.

The fund application window is March 16–April 16, 2026. Applications are due by 5:00pm EDT on April 16, 2026. For all funds except the International Fund, applications for expenses incurred between November 18th, 2025 and April 16th, 2026 will be considered. For the International Fund, applications for expenses incurred between April 18th, 2025 and April 16th, 2026 will be considered.

All information is required and must be filled out completely for your application to be processed.
Name*

First NameLast Name
Preferred Email Address*
example@example.com
Yale UPI*
Bargaining Unit Job Title*
i.e., TF, RA; see your appointment letter
Documentation of Bargaining Unit job i.e. appointment letter or pay slip*

Cancelof
Start Date of Bargaining Unit Job*

DayMonthYear
Date
YesNo
End Date of Bargaining Unit Job*

MonthDayYear
Date
Department/School of Enrollment*
Degree Program of Enrollment*
Description of Eligible Expenses & Expense Documentation

Maximum reimbursement per cycle: $3,000
Total reimbursement requested:*
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Please attach documentation for each eligible expense (copies of invoice or bill AND receipt or other proof of payment which matches the invoice or bill). Applicants may redact personal health information on documents so long as the date of payment, recipient of payment’s full name, and amount of payment are clearly visible on all documentation. Documents provided as part of this application will not be returned to applicants.
File Upload*

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Health Care Fund Application

Description of Eligible Expenses & Expense Documentation